Stakeholder Engagement Plan (SEP) Rwanda COVID-19 Emergency Response Project

1. Introduction/Project Description In March 2020, the World Health Organization (WHO) declared the ongoing coronavirus outbreak a global pandemic with the outbreak spiraling out of control and putting strains on health systems across several continents. The WHO recently warned that the “window of opportunity is narrowing" to contain the Public Disclosure Authorized deadly coronavirus disease (COVID-19) that originated in China and has spread to 215 countries. WHO statistics on COVID-19 show May 6, 2020 global confirmed cases at 3,634,172 cases with 251,446 confirmed deaths. As of May 6, 2020 Rwanda’s RBC published 268 confirmed cases, 130 recoveries (138 active cases) and no fatalities so far. The corona virus is highly contagious and easily transmitted and there are still many unknowns about COVID-19, especially as asymptomatic patients appear to be able to easily transmit the virus. The government of Rwanda has demonstrated high-level leadership and taken swift action to tackle the risks associated with the ongoing pandemic and bend the curb on COVID-19. The effort to contain the potential spread of COVID-19 is led by the Office of the Prime Minister under the National Epidemic Preparedness & Response Coordination Committee (NEPRCC), in collaboration with the Ministry of Health, Ministry of Local Government and Ministry of Foreign Affairs. The government put in place a

Public Disclosure Authorized mandatory national lockdown on March 21, 2020 until April 30, 2020 subject. The lockdown was partially lifted from May 4, 2020 by maintaining a 5am to 8pm curfew, social distancing, and use of masks while in public as well as variety of travel (motorcycle taxi ban remains in force) and other restrictions to be reviewed in 15 days. Borders remain closed and congregational activities including closing schools, and higher education institutions, churches and conferences remain suspended. Home-based work for non- essential civil service remains inforce. All commercial passenger flights to and from Rwanda remain suspended since March 20, 2020. The government has taken several other complementary actions to enhance preparedness. Authorities have conducted a preliminary risk assessment which highlighted key risk factors for importation of the coronavirus into the country. The Ministry of Health has expeditiously activated its Emergency Operation Centre and has established a Coronavirus National Taskforce to coordinate the national response.

Public Disclosure Authorized Rwanda has strengthened surveillance at all entry points; placed a high alert among health care workers and strengthened community-based disease surveillance. The government is promoting handwashing best practices with President Kagame taking part in the ‘Safe Hands’ challenge to encourage the public to emulate these behaviors. The country has recently benefited from a grant contribution of testing kits from Jack Ma foundation that will help in quickly initiating testing. With proactive containment measures, the loss of life and economic impact of the outbreak could be arrested. It is hence critical for the international community to work together on the underlying factors that are enabling the outbreak, on supporting policy responses, and on strengthening response capacity in developing countries – where health systems are weakest, and hence populations most vulnerable. The Rwanda COVID-19 Emergency Response Project aims to strengthen the Government of Rwanda’s capacity to be prepared to respond to the COVID-19 outbreak. The Rwanda COVID-19 Emergency Response Project comprises the following components: Public Disclosure Authorized a) Component 1. Case Detection, Confirmation and Contact Tracing (US$5.9 million): The focus will be on: (i) screening travelers at 31 Ports of Entry; as well as priority communities and targeted health facilities; (ii) carrying out contact tracing to minimize risk of transmission; (iii) conducting risk assessments to identify hot spot areas of transmission and provide timely information to

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policymakers; and (iv) carrying out multi-sectoral simulation exercises. To this end, the project will fund: (i) medical supplies and equipment; (ii) training and capacity building for frontline workers; (iii) operating costs for Rapid Response Teams and recruitment of additional personnel. b) Component 2: Public Health Measures and Clinical Care Capacity (US$8.0 million): The project will fund: (i) production and dissemination of communication materials and national and local campaigns to raise awareness; (ii) medical and laboratory equipment and supplies and waste management equipment and supplies; (iii) minor civil works (mainly refurbishments); and (iv) operating costs, including recruitment of additional clinical personnel. c) Component 3. Program/Project Implementation and Monitoring & Evaluation (US$.35 million) The third component will support program coordination, management and monitoring; operational support and logistics; and project management. This will include support for the COVID-19 Incident Management System Coordination Structure; operational reviews to assess implementation progress and adjust operational plans; and provide logistical support. To this end, the project will fund: (i) technical assistance; (ii) vehicles to facilitate transport; and (iii) operating costs. The Rwanda COVID-19 Emergency Response Project is being prepared under the World Bank’s Environment and Social Framework (ESF). As per the Environmental and Social Standard ESS 10 Stakeholders Engagement and Information Disclosure, the implementing agencies should provide stakeholders with timely, relevant, understandable and accessible information, and consult with them in a culturally appropriate manner, which is free of manipulation, interference, coercion, discrimination and intimidation. The overall objective of this SEP is to define a program for stakeholder engagement, including public information disclosure and consultation, throughout the entire project cycle. The SEP outlines the ways in which the project team will communicate with stakeholders and includes a mechanism by which people can raise concerns, provide feedback, or make complaints about project and any activities related to the project. The involvement of the local population is essential to the success of the project in order to ensure smooth collaboration between project staff and local communities and to minimize and mitigate environmental and social risks related to the proposed project activities. In the context of infectious diseases, broad, culturally appropriate, and adapted awareness raising activities are particularly important to properly sensitize the communities to the risks related to infectious diseases. 2. Stakeholder identification and analysis Project stakeholders are defined as individuals, groups or other entities who: (i) are impacted or likely to be impacted directly or indirectly, positively or adversely, by the Project (also known as ‘affected parties’); and (ii) may have an interest in the Project (‘interested parties’). They include individuals or groups whose interests may be affected by the Project and who have the potential to influence the Project outcomes in any way. Cooperation and negotiation with the stakeholders throughout the Project development often also require the identification of persons within the groups who act as legitimate representatives of their respective stakeholder group, i.e. the individuals who have been entrusted by their fellow group members with advocating the groups’ interests in the process of engagement with the Project. Community representatives may provide helpful insight into the local settings and act as main conduits for dissemination of the Project-related information and as a primary communication/liaison link between the Project and targeted communities and their established networks. Verification of stakeholder

2 representatives (i.e. the process of confirming that they are legitimate and genuine advocates of the community they represent) remains an important task in establishing contact with the community stakeholders. Legitimacy of the community representatives can be verified by talking informally to a random sample of community members and heeding their views on who can be representing their interests in the most effective way. 2.1 Methodology In order to meet best practice approaches, the project will apply the following principles for stakeholder engagement: • Openness and life-cycle approach: public consultations for the project(s) will be arranged during the whole life-cycle, carried out in an open manner, free of external manipulation, interference, coercion or intimidation; • Informed participation and feedback: information will be provided to and widely distributed among all stakeholders in an appropriate format; opportunities are provided for communicating stakeholders’ feedback, for analyzing and addressing comments and concerns; • Inclusiveness and sensitivity: stakeholder identification is undertaken to support better communications and build effective relationships. The participation process for the projects is inclusive. All stakeholders at all times encouraged to be involved in the consultation process. Equal access to information is provided to all stakeholders. Sensitivity to stakeholders’ needs is the key principle underlying the selection of engagement methods. Special attention is given to vulnerable groups, in particular women, youth and the elderly. For the purposes of effective and tailored engagement, stakeholders of the proposed project(s) can be divided into the following core categories: • Affected Parties – persons, groups and other entities within the Project Area of Influence (PAI) that are directly influenced (actually or potentially) by the project and/or have been identified as most susceptible to change associated with the project, and who need to be closely engaged in identifying impacts and their significance, as well as in decision-making on mitigation and management measures; • Other Interested Parties – individuals/groups/entities that may not experience direct impacts from the Project but who consider or perceive their interests as being affected by the project and/or who could affect the project and the process of its implementation in some way; and • Vulnerable Groups – persons who may be disproportionately impacted or further disadvantaged by the project(s) as compared with any other groups due to their vulnerable status1, and that may require special engagement efforts to ensure their equal representation in the consultation and decision- making process associated with the project. 2.2. Affected parties Affected Parties include local communities, community members and other parties that may be subject to direct impacts from the Project. Specifically, the following individuals and groups fall within this category:

• COVID19 infected people • People under COVID19 quarantine • Relatives of COVID19 infected people

1 Vulnerable status may stem from an individual’s or group’s race, national, ethnic or social origin, color, gender, language, religion, political or other opinion, property, age, culture, literacy, sickness, physical or mental disability, poverty or economic disadvantage, and dependence on unique natural resources. 3

• Relatives of people under COVID19 quarantine • Neighboring communities to laboratories, quarantine centers, and screening posts • Workers at renovation/refurbishment sites for isolation and treatment centers, laboratories, quarantine centers and screening posts • People at COVID-19 risks (travelers, inhabitants of areas where cases have been identified, etc.) • Public Health Workers • Private Health Workers mobilized by MoH/RBC for COVID-19 IPC activities • Medical waste collection and disposal workers • MoH and Rwanda Biomedical Center (RBC) • Other Public authorities • Airline and border control staff • Airlines and other international transport business personnel • Africa Center for Disease Control (CDC) and WHO 2.3. Other interested parties The projects’ stakeholders also include parties other than the directly affected communities, including: • Traditional media • Participants of social media • Private Sector Federation • Religious institutions • Schools • Politicians • Other national and international health organizations • Other International NGOs • Businesses with international links • The public at large 2.4. Disadvantaged / vulnerable individuals or groups Rwanda has become the first country in sub-Saharan Africa to take the necessary measure to order a total shutdown because of the coronavirus. WHO statistics on COVID-19 show May 6, 2020 global confirmed cases at 3,634,172 cases with 251,446 confirmed deaths over 215 countries. As of May 6, 2020 Rwanda’s RBC published 268 confirmed cases, 130 recoveries (138 active cases) and no fatalities so far. All unnecessary movements outside the home have been banned for an initial two weeks except for essential services such as health care and shopping for groceries. Both public and private workers have also been ordered to work from home to help prevent the spread of COVID-19. As a result of lack of resources to prepare and protect against the coronavirus, the poor face a higher risk of contracting and subsequently spreading the virus. Informal sector workers, construction workers, and those in low-income jobs or in jobs that cannot be performed remotely, are most vulnerable, as these people often have no savings to weather the storm, and even stocking up on food can represent an impossible financial hurdle. The harm inflicted on especially urban poor and many women heads of households, is likely to be devastating. In informal urban settlements, families occupy cramped informal dwellings, and just barely survive by casual jobs in the city, work that has now stopped. It is particularly important to understand whether project impacts may disproportionately fall on disadvantaged or vulnerable individuals or groups, who often do not have a voice to express their concerns or understand the impacts of a project and to ensure that awareness raising and stakeholder 4 engagement with disadvantaged or vulnerable individuals or groups on infectious diseases and medical treatments in particular, be adapted to take into account such groups or individuals particular sensitivities, concerns and cultural sensitivities and to ensure a full understanding of project activities and benefits. The vulnerability may stem from, gender, age, health condition, economic deficiency and financial insecurity, disadvantaged status in the community (e.g. people with disabilities), dependence on other individuals or natural resources, etc. Engagement with the vulnerable groups and individuals often requires the application of specific measures and assistance aimed at the facilitation of their participation in the project-related decision making so that their awareness of and input to the overall process are commensurate to those of the other stakeholders. Within the Project, the vulnerable or disadvantaged groups may include and are not limited to the following: • Elderly • Illiterate people • People with disabilities • Refugees • Female-headed households • Child headed households • Poor households Vulnerable groups within the communities affected by the project will be further confirmed and consulted through dedicated means, as appropriate. Description of the methods of engagement that will be undertaken by the project is provided in the following sections.

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Stakeholder Engagement Plan (SEP) Rwanda COVID-19 Emergency Response Project

3. Stakeholder Engagement Program 3.1. Summary of stakeholder engagement done during project preparation Due to the emergency situation, and the need to address issues related to COVID19, only national and decentralized health sector officials and district administration authorities were consulted during project preparation. The consultations were held after extended delays associated with in-country movement restrictions and selective lockdowns in outbreak districts and neighborhoods. A senior level virtual consultation with stakeholders in district administration of the health sector was conducted on this ESMF on Oct 16, 2020 using a video conference facility hosted by the Ministry of Local Government (MINALOC). Participants included District Executive Secretaries, Directors General of District Hospitals, District Directors of Health, District Hygiene and Sanitation Officers and Hospital Environmental Health Officers. The consultation session was facilitated by the MoH/RBC-SPIU Coordinator and the designated ERP Social Specialist. The ERP environmental Specialist and members of the MoH Environmental Health Desk participated in the consultation. Over 90 officials participated in the virtual consultation session, although less registered themselves in the VC system (Annex III). Earlier in the week consultation sessions on this ESMF were slotted in the Environmental Safeguards training programme from Oct 12 to Oct 15, 2020 for District Hygiene and Sanitation Officers (DHSOs) and District Hospital Environmental Health Officers (EHO) and Health Centre Community Environmental Health Officers (C-EHOs) for 4 districts. 33 officers from Nyabihu and Ngororero districts were consulted on the ESMF on Oct 12, and 31 officers from Rubavu and Rutsiro districts consulted on Oct 14, 2020 (Annex IV). A summary of key issues raised are provided in Annex V. The consultations provided critical information to key stakeholders in the health sector. Important questions and comments included from grievances emerging from property damage caused by decontamination activities associated with contact-tracing for IPC of COVID-19 such as use of chemicals on equipment surfaces. Stakeholders were informed of the GRM that in place for grievance resolution associated with ERP activities. Stakeholders were also concerned with medical waste management challenges faced by HCFs and wondered whether or not the ERP would address them, especially towards the need for incinerators. A critical aspect of waste management raised related to waste management of the current homecare for COVID-19 patients. This aspect should be addressed by RBC. Another critical issue raised by stakeholders was the overstretched situation of HCWs. The PUI was able to explain that the countries were generally under stress and that the RBC would try to make-do with the resources that were available and that no resources were available in the ERP or from elsewhere for recruit more staff. It was noted that some participants experienced poor connectivity during the VC consultation proceedings. It would be useful to assess connectivity challenges in an effort to enhance and improve participation.

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3.2. Summary of project stakeholder needs and methods, tools and techniques for stakeholder engagement To ensure effective communication WHO has developed the Risk Communication and Community Engagement (RCCE) readiness and response to the 2019 novel coronavirus to guide governments. The document provides checklists developed by WHO for risk communication and community engagement (RCCE) readiness. The checklists shown in Figure 1 provide actionable guidance for countries to implement effective RCCE strategies that will help protect the public’s health during the early response to COVID-19. To support these efforts, the project has included resources for RCCE, encompassing behavioral and sociocultural risk factor assessments, production of communication materials, media and community engagement, and documentation in line with WHO guidance on risk communication and community engagement found at https://www.who.int/emergencies/diseases/novel-coronavirus-2019/technical- guidance/risk-communication-and-community-engagement. The approaches taken will thereby ensure that information is meaningful, timely, and accessible to all affected stakeholders, including use of

Figure 1 WHO checklists for risk communication and community engagement (RCCE) readiness materials in the local language, addressing cultural sensitivities, as well as challenges deriving from illiteracy or disabilities. 3.3. Stakeholder engagement plan The Bank recently provided a Technical Note titled “Public Consultations and Stakeholder Engagement in WB-supported operations when there are constraints on conducting public meetings” with respect to the outbreak and spread of COVID-19. The Note makes due reference to the WHO technical guidance in dealing with COVID-19, including: (i) Risk Communication and Community Engagement (RCCE) Action Plan

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Guidance Preparedness and Response; (ii) Risk Communication and Community engagement (RCCE) readiness and response; (iii) COVID-19 risk communication package for healthcare facilities; (iv) Getting your workplace ready for COVID-19; and (v) a guide to preventing and addressing social stigma associated with COVID-19. All these documents are available on the WHO website through the following link: https://www.who.int/emergencies/diseases/novel-coronavirus-2019/technical-guidance. The Technical Note lays out suggestions for the task team and the PIU subject to the COVID-19 in-country situation and restrictions in force. The following are applicable to the Rwanda COVID-19 ERP: • Be sure that all task team and PIU members articulate and express their understandings on social behavior and good hygiene practices, and that any stakeholder engagement events be preceded with the procedure of articulating such hygienic practices. • Avoid public gatherings (taking into account national restrictions), including public hearings, workshops and community meetings, and minimize direct interaction between project agencies and beneficiaries / affected people; • If smaller meetings are permitted, conduct consultations in small-group sessions, such as focus group meetings. If not permitted, make all reasonable efforts to conduct meetings through online channels, including WebEx and skype meetings; • Diversify means of communication and rely more on social media and online channels. Where possible and appropriate, create dedicated online platforms and chat-groups appropriate for the purpose, based on the type and category of stakeholders; • Employ traditional channels of communications (TV, newspaper, radio, dedicated phone-lines, public announcements and mail) when stakeholders do not have access to online channels or do not use them frequently. Such channels can also be highly effective in conveying relevant information to stakeholders, and allow them to provide their feedback and suggestions; • Employ online communication tools to design virtual workshops in situations where large meetings and workshops are essential, given the preparatory stage of the project. WebEx, Skype, and in low ICT capacity situations, audio meetings, can be effective tools to design virtual workshops. The format of such workshops could include the following steps: o Virtual registration of participants: Participants can register online through a dedicated platform. o Distribution of workshop materials to participants, including agenda, project documents, presentations, questionnaires and discussion topics: These can be distributed online to participants. o Review of distributed information materials: Participants are given a scheduled duration for this, prior to scheduling a discussion on the information provided.

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o Discussion, feedback collection and sharing: ▪ Participants can be organized and assigned to different topic groups, teams or virtual “tables” provided they agree to this. ▪ Group, team and table discussions can be organized through social media means, such as WebEx, skype or through written feedback in the form of an electronic questionnaire or feedback forms that can be emailed back. o Conclusion and summary: The chair of the workshop will summarize the virtual workshop discussion, formulate conclusions and share electronically with all participants. • In situations where online interaction is challenging, information can be disseminated through digital platform (where available) like Facebook, Twitter, WhatsApp groups, Project web links/ websites, and traditional means of communications (TV, newspaper, radio, phone calls and mails with clear description of mechanisms for providing feedback via mail and / or dedicated telephone lines. All channels of communication need to clearly specify how stakeholders can provide their feedback and suggestions. National Preparedness and Response Plan for COVID-19 The Government of Rwanda through the Ministry of Health launched a six month COVID-19 National Preparedness and Response Plan under the oversight of the National Epidemic Preparedness and Response Committee led by the Office of the Prime Minister. One of main objectives of the plan is to “Create and raise public awareness for engagement on COVID-19 preparedness and response activities”. The MoH has adopted the RCCE developed by WHO as the implementation strategy of this objective through the following activities: • Develop a national RCCE plan for COVID-19 (this plan) • Conduct a rapid behavior assessment to understand hey target audience and preferred communication channels • Prepare and pre-test local messages through various media • Train health promotion officers at sub-national levels • Identify trusted community groups or individuals (local influencers) and local networks • Identify relevant communication channels and disseminate messages • Conduct radio and TV talk shows and develop public service announcements (PSAs) • Establish community information and feedback mechanism • Document lessons learned to inform future preparedness and response activities • Print Information and Education Communication (IEC) materials • Print factsheets for airline cabin crew, Community Health Workers (CHWs), Red Cross volunteers, religious leaders, local authorities, school teachers and drivers of public transport • Develop and display electronic billboard posters • Produce and air a short video on COVID-19 prevention and basic infection prevention and hygiene messages • Disseminate daily tips on COVID-19 prevention on TV • Send SMS messages on COVID-19 prevention to the general population Capacity of implementing RCCE of the National Preparedness and Response Plan for COVID-19 The Rwanda Health Communication Centre (RHCC) is a unit of the RBC/MoH mandated with the coordination of health promotion interventions, handling media and public relations within the country’s health sector. The RHCC identifies and develops effective messaging to reach the sector’s communication objectives. It manages social media handles and websites of RBC/MoH to continuously inform the public.

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The RHCC operates the 114 Hotline call-centre for healthcare information, counselling, and facilitates access of health services to the population from Monday to Saturday of every week. The Center operated a Documentation Centre as a clearing house for health sector information and resources including social behavior change communication materials with electronic, print and audio-visual tools. The RHCC is full deployed in the implementation of Rwanda’s RCCE, where necessary disseminating messages and obtaining feedback through national radio, TV, mobile phone SMS and social media platforms. Engagement Procedure for the Rwanda COVID-19 ERP Stakeholder engagement will be carried out using the recommended methods provided in the Rwanda RCCE plan and in the guidance provided in the Bank’s Technical Note as described above and summarized in Table 1 below:

Table 1 Stakeholder engagement procedure in compliance with ESS10 using the Rwanda RCCE plan methods

Stakeholder Group Engagement Methods

GoR Ministries, Institutions and Agencies: Email and text messages • MoH/RBC; Africa CDC and WHO; Formal Video Conference meetings • MoE; REMA; RDB; RHA; • Immigration & Emigration (border control) /Civil Electronic Factsheets with text message feedback Aviation Authority/Airports Company of contact details Rwanda/Airlines; One-On-One phone conversations • MINECOFIN/Customs; • MINEMA; MINALOC/LODA; MINICOM; • MININFRA/RTDA/Public Transport/ Road Transport Industry (cooperatives) Project Affected Persons (Contact risk): Radio and TV Public Service Announcements; social • COVID19 infected people medial announcements; text messaging; Virtual Focus • People under COVID19 quarantine Group Discussions; • Relatives of COVID19 infected people One-On-One phone conversations • Relatives of people under COVID19 quarantine • Travelers and inhabitants of areas where cases have Electronic Factsheets with text message feedback been identified contact details • Public Health Workers Focus Group Discussions with minimum number of • Private Health Workers mobilized by MoH/RBC for participants according to national social-distancing COVID-19 IPC activities advisory/guidelines • Medical waste collection and disposal workers • Airline and border control staff • Other international transport business personnel Project Affected Persons (High risk areas): Focus Group Discussions with minimum number of • ERP workers at renovation/refurbishment sites for participants according to national social-distancing isolation and treatment centers, laboratories, advisory/guidelines quarantine centers and screening posts Virtual Focus Group Discussions with local influencers • Neighboring communities to laboratories, quarantine and local network reps centers, and screening posts Electronic billboard posters with text feedback contact details

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Stakeholder Group Engagement Methods

Disadvantaged/ Vulnerable Individuals or Groups: Focus Group Discussions with minimum number of • Elderly participants according to national social-distancing • Illiterate people advisory/guidelines • People with disabilities Virtual Focus Group Discussions with local influencers • Refugees and local network reps • Female-headed households • Child headed households One-On-One phone conversations • Poor households Other Affected Groups: Radio and TV talk shows with a phone-in feedback • Traditional media facility • Participants of social media Electronic billboard posters with text feedback contact • Private Sector Federation details • Religious institutions • Schools Electronic Factsheets with text message feedback • Higher Education Institutions contact details • Other national and international health organizations Short video broadcasts with text message feedback • Politicians contact details • Other NGOs • Businesses with international links Virtual Focus Group Discussions • The public at large One-On-One phone conversations

Overall supervision for this ESMF will be the responsibility of the MoH. Consultations between the preparation team for ESF instruments and members of the MoH and RBC-SPIU confirmed adequate capacity for the required implementation requirements within the existing human resources and operational structures of the ministry and within environmental health officials in beneficiary district administrations, hospitals and health centers (Figure 2). The RBC SPIU as the PUI is mandated with the responsibility for implementing ESF instruments for the Rwanda COVID-19 ERP having designated an Environmental Specialist and Social Specialist to oversee the implementation of this ESMF and SEP (Figure 2). The Environmental Specialist will arrange and carry out SEP activities that assisted by District Hygiene and Sanitation Officers (DHSOs) at District Administration level, by Hospital Environmental Health Officers (HEOs) at Referral, Provincial and Districts hospital level and by Community Environmental Health Officers (C-EHOs) at Health Centre level. The Level, method and activity of engagement to be applied will be identified by the ERP Social Specialist under the supervision of the RBC-SPIU as the project implementation unit (PUI) before contacting target stakeholders. The ERP Social Specialist will be responsible for the documentation of the stakeholder engagement activities under this Project and will be responsible for quarterly reporting on the SEP.

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Joint COVID-19 Task Force Coordination (JTFC) MoH/RBC-SPIU

Command PIU Coordinator Post

KEY ES SS ES: Environmental Specialist SS: Social Specialist EHO: Environmental Health Officer CCH: Coordinator of Community Based Environmental Health Promotion Program C-EHO: Community Environmental Health Officer DHSO: District Hygiene & Sanitation Officer District Administration: (Screening Posts; Centres of DHSO DHSO DHSO DHSO Quarantine; Contact Tracing)

Hospitals (all levels): GRM • Supervisors (IPC; Isolation & Treatment EHO EHO EHO EHO • Health Facility Specialist • Contractors • Health & Safety Facilities) Committees • Consultants

Health Centres & CEHO CEHO CEHO CEHO Community Surveillance

Figure 2 Rwanda COVID-19 ERP Implementation arrangements for the ESF instruments including SEP

Stakeholder engagement activities may be iterative through the project’s lifecycle based on comments received that may identify new important stakeholders. 3.4. Proposed strategy for information disclosure and consultation process In terms of methodology, it will be important that the different activities are inclusive and culturally sensitive, thereby ensuring that the vulnerable groups outlined above will have the chance to participate in the Project benefits. This can include household-outreach and focus-group discussions in addition to village consultations, the use of verbal communication in Kinyarwanda or pictures instead of text, etc. The project will thereby have to adapt to different requirements. While country-wide awareness campaigns will be established, specific communication around borders and international airport as well as quarantine centers and laboratories will have to be timed according to need and be adjusted to the specific local circumstance. An Environmental and Social Management Framework (ESMF) for the Rwanda COVID-19 ERP that has incorporated an Environmental and Social Management Plan (ESMP) and Labor Management Plan (LMP) as well as this SEP will be disclosed prior to formal consultations. 3.5 Future of the project Stakeholders will be kept informed as the project develops, including reporting on project environmental and social performance and implementation of the stakeholder engagement plan and grievance mechanism. This will be important for the wider public, but equally and even more so for suspected and/or identified COVID-19 cases as well as their relatives.

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Stakeholder Engagement Plan (SEP) Rwanda COVID-19 Emergency Response Project

4. Resources and Responsibilities for implementing stakeholder engagement activities 4.1. Resources The Ministry of Health will be in charge of stakeholder engagement activities. The budget for the SEP is part of the 8.0 million USD, included in Component 2 as an activity of “production and dissemination of communication materials and national and local campaigns to raise awareness”. 4.2. Management functions and responsibilities The institutional, implementation and coordination arrangements for the project will leverage existing platforms and seek to strengthen capacities and systems for implementation of disease outbreak response and preparedness capacity. The Ministry of Health (MoH) will be supported to handle its policy and strategy formulation roles and responsibilities, ensuring oversight and coordination. The Coronavirus National Taskforce will coordinate the national response and provide strategic and operational guidance for the implementation of that national program and the proposed project. The taskforce includes representatives of key ministries (e.g., Ministry of Health Ministry of Local Government) and the key development partners active in the health sector, hence it is well placed to provide general oversight and advice. The taskforce will review progress and take stock of lessons learned. The taskforce will meet every six months or more often as needed. The first meeting each year will approve the annual work plan for the project, and the associated budget. Subsequent meetings will monitor performance and budget execution. The Rwanda Biomedical Center, the nation's central health implementation agency under the MoH will be responsible for overall project management through the Single Project Implementation Unit (SPIU) which has a long-standing sound track record of implementing several World Bank funded health investment operations. The RBC/SPIU will handle the following functions: (i) financial management, including flow of funds to different stakeholders; (ii) procurement of goods, medical and laboratory equipment, and supplies to ensure economies of scale and efficiencies; (iii) securing consultant services; and (iv) oversight of social and environmental safeguard provisions. To handle the additional workload from the project, the SPIU will recruit a Project Focal Point and other relevant staff as and when needed and as agreed with the World Bank. 5. Grievance Mechanism The main objective of a Grievance Redress Mechanism (GRM) is to assist to resolve complaints and grievances in a timely, effective and efficient manner that satisfies all parties involved. Specifically, it provides a transparent and credible process for fair, effective and lasting outcomes. It also builds trust and cooperation as an integral component of broader community consultation that facilitates corrective actions. Specifically, the GRM: ▪ Provides affected people with avenues for making a complaint or resolving any dispute that may arise during the course of the implementation of projects; ▪ Ensures that appropriate and mutually acceptable redress actions are identified and implemented to the satisfaction of complainants; and ▪ Avoids the need to resort to judicial proceedings. 5.1. Description of GRM Grievances will be handled at the District Level by the Officer in charge of Social Affairs and on the national level by MoH and RBC, including via dedicated hotline to be established. The ERP Social Specialist will prepare a grievances register that will be maintained by Contractors at ERP activity sites. Contractors will

13 record grievances and forward the information to the designated facilitation officer for GRM at the ERP beneficiary HCF and to the District Social Affairs officer for appropriate action. The GRM facilitation function is the responsibility of the following ERP-designated officers as indicated in Figure 2: • District Sanitation and Hygiene Officers (DSHOs) at District Administration level (ERP works for Screening Posts, Centers of Quarantine and Contact Tracing); • Hospital Environmental Officers (HEOs) at Referral, Provincial and District hospital levels (ERP works for IPC at Isolation & Treatment Facilities); and • Environmental Health Officers (EHOs) at ERP works for Health Centers. The GRM will include the following steps as illustrated in Figure 3: Step 0: Grievance discussed with the respective health facility Step 1: Grievance raised with the District Social Affairs Office or IOSC in case of GVB Step 2: Appeal to the Provincial Department of Social Affairs Office Step 3: Appeal to the Rwanda Office of the Ombudsman and/or the Ministry of Health/RBC. Once all possible redress has been proposed and if the complainant is still not satisfied then they should be advised of their right to legal recourse.

Aggrieved Grievance Step 0 Step 1 Health Facility Appeal District Social Affairs registration Party (24hrs) Office (1-2days)

GBV complaint

Appeal GVB Task Force/ Isange One-Stop Center (1-12hrs) Step 2 Grievance Resolution Provincial Social Affairs Office (1- 2days) National Court System MoH-RBC

Step 3 Appeal Ombudsman Appeal

Figure 3 Grievance Redress Mechanism for the Rwanda ERP

However, in case of incidents of Gender Base Violence (GVB), there is need for timely access to quality, multi-sectoral services and involves confidentiality and informed consent of the survivor. GVB complaints will therefore be directed to the Isange One Stop Center (IOSC) by DSHOs, HEOs or EHOs as GRM facilitators. The IOSC is a specialized free-of-charge referral center where survivors of GVB can find comprehensive services such as: medical care; psychosocial support; police and legal support, and collection of legal evidence. IOSC works closely with police stations, sector, cell and village leaders in surrounding areas, community police, hospitals and health centers.

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ERP Social Specialist will ensure that bidding and subsequent contract documents clearly define GBV/SEA/SH requirements, including the requirement for a Code of Conduct (CoC). During works, separate facilities will be provided for women and men with GBV-free zone signage. The Social Specialist will provide information to all contractors with contact details the IOSC. Consultations with the RBC-SPIU (PIU) indicated that no grievances had been registered within the ERP. However, recent consultations with health sector officials and national and decentralized levels as well as district administration authorities revealed that grievances had emerged related to damage of property items and equipment resulting from COVID-19 decontamination activities where infections had been confirm or contacts with infected individuals had been tranced. The ESF team advised that these grievances be registered in the GRM and brought to the attention of the HCF’s Health and Safety Committee through the designated ERP Social Specialist. In the instance of the COVID 19 emergency, existing grievance procedures should be used to encourage reporting of co-workers if they show outward symptoms, such as ongoing and severe coughing with fever, and do not voluntarily submit to testing. 6. Monitoring and Reporting

The SEP will be periodically revised and updated as necessary in the course of project implementation in order to ensure that the information presented herein is consistent and is the most recent, and that the identified methods of engagement remain appropriate and effective in relation to the project context and specific phases of the development. Any major changes to the project related activities and to its schedule will be duly reflected in the SEP. Quarterly summaries and internal reports on public grievances, enquiries and related incidents, together with the status of implementation of associated corrective/preventative actions will be collated by ERP Social Specialist and referred to the senior management of the project. The quarterly summaries will provide a mechanism for assessing both the number and the nature of complaints and requests for information, along with the Project’s ability to address those in a timely and effective manner. Information on public engagement activities undertaken by the Project during the year may be conveyed to the stakeholders in two possible ways: • Publication of a standalone annual report on project’s interaction with the stakeholders. • A number of Key Performance Indicators (KPIs) will also be monitored by the project on a regular basis. The following KPIs will be monitored: • Number of consultation activities and other public interactive engagements with stakeholders conducted within a reporting period (e.g. monthly, quarterly, or annually); • Frequency of public engagement activities; • Geographical coverage of public engagement activities • Number of participants in different engagement activities (where applicable) • Newly identified stakeholders • Number of Universities covered by the consultation process; • Number and details of vulnerable individuals involved in consultation processes; • Number of public grievances received within a reporting period (e.g. monthly, quarterly, or annually) and number of those resolved within the prescribed timeline; • Type of public grievances received; and • Number of press materials published/broadcast by type of media.

Annexes

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I. Abbreviations and Acronyms II. Documents Consulted III. Participants’ Chat Record: Virtual Stakeholder Consultation of Oct 16 2020 IV. DHSOs/EHOs/C-EHOs Consolation Oct 12-15, 2020 V. Summary of key issues raised in Stakeholder Consultations

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Stakeholder Engagement Plan (SEP) Rwanda COVID-19 Emergency Response Project

I. Abbreviations and Acronyms

CCH Coordinator of Community-based Environmental Health Promotion Program CDC Center for Diseases Control COVID-19 Coronavirus Disease 2019 DSHO District Sanitation & Hygiene Officer EHO Environmental Health Officer ERP Emergency Response Project ESF Environmental and Social Framework ESMF Environmental and Social Management Framework ESMP Environmental and Social Management Plan ESR Epidemic Surveillance Response GBV Gender Based Violence HCF Healthcare Facility ICT Information Communication Technology IEC Information and Education Communication IOSC Isange One-Stop-Center LMP Labor Management Plan LODA Local Administrative Entities Development Agency MINALOC Ministry of Local Government MINECOFIN Ministry of Economic Planning and Finance MINEMA Ministry in Charge of Emergency Management MINICOM Ministry of Trade and Industry MININFRA Ministry of Infrastructure MOE Ministry of Environment MOH Ministry of Health NEPRCC National Epidemic Preparedness & Response Coordination Committee NGO Non-Governmental Organizations PIU Project Implementation Unit RBC Rwanda Biomedical Centre RCCE Risk Communication and Community Engagement RDB Rwanda Development Board REMA Rwanda Environment Management Authority RHA Rwanda Housing Authority RHCC Rwanda Health Communication Centre RTDA Rwanda Transport Development Agency SMS Short Message System SPIU Single Project Implementation Unit TV Television POE Point of Entry SEA Sexual Exploitation and Abuse SH Sexual Harassment SEP Stakeholder Engagement Plan WB World Bank WHO World Health Organization

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Stakeholder Engagement Plan (SEP) Rwanda COVID-19 Emergency Response Project

II. Documents Consulted and Resource Material Government of Rwanda • Coronavirus Disease 2019, National Preparedness and Response Plan March-August 2020 • Cabinet communiqué - 06/03/2020 at https://www.primature.gov.rw/index.php?id=131&tx_news_pi1%5Bnews%5D=902&tx_news_pi 1%5Bcontroller%5D=News&tx_news_pi1%5Baction%5D=detail&cHash=81ece6c56761c61b4c7c9 22c0fda06ce WHO technical guidance at: https://www.who.int/emergencies/diseases/novel-coronavirus- 2019/technical-guidance • Risk Communication and Community Engagement (RCCE) Action Plan Guidance Preparedness and Response • Risk Communication and Community engagement (RCCE) readiness and response • COVID-19 risk communication package for healthcare facilities • Getting your workplace ready for COVID-19 • A guide to preventing and addressing social stigma associated with COVID-19 Word Bank technical note • Technical Note: Public Consultations and Stakeholder Engagement in WB-supported operations when there are constraints on conducting public meetings, March 2020 • Project Appraisal Document for RWANDA COVID-19 Emergency Response Project, April 2020 • Environmental and Social Commitment Plan (ESCP) for Rwanda COVID-19 Emergency Response Project, March 2020 • Environmental and Social Review Summary (ESRS) Appraisal Stage for Rwanda COVID-19 Emergency Response Project, March 2020

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III. Participants’ Chat Record: Virtual Stakeholder Consultation of Oct 16 2020 Kanyamarere Leonard from Munini DH from user to everyone: 10:13 AM Dr DUFATANYE Erhard,Clinical director MUNINI DH from Mujawayezu Odette to everyone: 10:37 AM Amajwi ntabwo yumvikana from Rutarindwa Alphonse to everyone: 10:46 AM gasabo abitabiriye: from RUSIMBUKAYEJO to everyone: 10:46 AM amajwi ameze nabi pe from Mwumvaneza MUTAGOMA to everyone: 10:47 AM Component 4, handitswe ko ari cost zero. from Mwumvaneza MUTAGOMA to everyone: 10:47 AM Is it possible? from Rutarindwa Alphonse to everyone: 10:48 AM Dir. of health .environmental health officer( district) . hygiene &sanitation officer (District).Epidemiological surveillance officer (DH). from anzakizwanayo to everyone: 10:48 AM Ruhango abitabiriye: Francoise NZAKIZWANAYO;EHO Ruhango provincial hospital. NKURIKIYIMANA Edmond ,DAF Ruhango provincial hospital. from Ntakirutimana Zacharie to everyone: 10:48 AM Ese muri waste management uyu mushinga uzaha ibitaro incinerator from Rutarindwa Alphonse to everyone: 10:49 AM Gasabo :Dir. of health .environmental health officer( district) . hygiene &sanitation officer (District).Epidemiological surveillance officer (DH). from Dr Issa Ngabonziza to everyone: 10:49 AM Dr Issa Ngabonziza DG Gatunda DH from Rutagengwa William to everyone: 10:50 AM Bugesera: Dr William Rutagengwa DG Nyamata Hospital from user to everyone: 10:12 AM Kanyamarere Leonard from Munini DH from user to everyone: 10:13 AM Dr DUFATANYE Erhard,Clinical director MUNINI DH from Mujawayezu Odette to everyone: 10:37 AM Amajwi ntabwo yumvikana from Rutarindwa Alphonse to everyone: 10:46 AM gasabo abitabiriye: from RUSIMBUKAYEJO to everyone: 10:46 AM amajwi ameze nabi pe from Mwumvaneza MUTAGOMA to everyone: 10:47 AM Component 4, handitswe ko ari cost zero. from Mwumvaneza MUTAGOMA to everyone: 10:47 AM Is it possible? from Rutarindwa Alphonse to everyone: 10:48 AM Dir. of health .environmental health officer( district) . hygiene &sanitation officer (District).Epidemiological surveillance officer (DH). from anzakizwanayo to everyone: 10:48 AM

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Ruhango abitabiriye: Francoise NZAKIZWANAYO;EHO Ruhango provincial hospital. NKURIKIYIMANA Edmond ,DAF Ruhango provincial hospital. from Ntakirutimana Zacharie to everyone: 10:48 AM Ese muri waste management uyu mushinga uzaha ibitaro incinerator from Rutarindwa Alphonse to everyone: 10:49 AM Gasabo :Dir. of health .environmental health officer( district) . hygiene &sanitation officer (District).Epidemiological surveillance officer (DH). from Dr Issa Ngabonziza to everyone: 10:49 AM Dr Issa Ngabonziza DG Gatunda DH from Rutagengwa William to everyone: 10:50 AM Bugesera: Dr William Rutagengwa DG Nyamata Hospital from Director Health Unit to everyone: 10:50 AM NDAYISABYE Viateur, Director of Health Unit/ Bugesera District. from Niringiyimana Eugene to everyone: 10:50 AM Dr Eugene NIRINGIYIMANA - DG Hopital Murunda / Rutsiro District from UWIZEYE PROTOGENE to everyone: 10:50 AM UWIZEYE PROTOGENE ENVIRONMENTAL HEALTH OFFICER KIBILIZI DH GISAGARA DISTRICT from Rutarindwa Alphonse to everyone: 10:50 AM Gasabo amazina yabitabiriye: from irankunda Innocent to everyone: 10:51 AM Irankunda Innocent,EHO of Butaro,Burera district. from user to everyone: 10:51 AM Karemera Athanase Dir of Health Nyaruguru from John Bosco NDUWAMUNGU to everyone: 10:52 AM nitwa Bosco shinzwe Isuku Kicukiro ku Karere mwazatekereza no kuri waste zizava muri community ijyanye na Covid 19 mubya home based care from Rutarindwa Alphonse to everyone: 10:52 AM Gasabo amazina yabitabiriye:ALPHONSE RUTARINDWA.Umwngirije Oswald. Dr.karemera M.Clairere. Tuyizere Vivine from RUSIMBUKAYEJO to everyone: 10:54 AM MUHANGA DISTRICT Attendance:RUSIMBUKAYEJO J.Baptiste ,KAYITESI Antoinette,KAYONGA Donathi,UMUTONIWASE KAMANA Sosthene from Ntakirutimana Zacharie to everyone: 10:54 AM Nitwa Ntakirutimana Zacharie EHO Mibilizi DH mwatekereza no kubitaro bidafite modern incinerator muri waste management from user to everyone: 10:57 AM Presentantion muziduhe from RUSIMBUKAYEJO to everyone: 10:57 AM Thanks. ari izo presentations turazikeneye from user to everyone: 10:57 AM [email protected] from Mbayire Vedaste to everyone: 10:57 AM [email protected] from Adrien KUBWIMANA to everyone: 10:57 AM [email protected] from irankunda Innocent to everyone: 10:58 AM [email protected] from user to everyone: 10:58 AM

20 [email protected] from RUSIMBUKAYEJO to everyone: 10:58 AM my email:[email protected] from John Bosco NDUWAMUNGU to everyone: 10:58 AM Kicukiro email:[email protected], [email protected] from Dr Placide NSHIZIRUNGU to everyone: 10:58 AM Nanjye muze kunyoherereza izo PPT presentations kuri [email protected] from kabera to everyone: 10:59 AM Nyanza District: from kabera to everyone: 10:59 AM Kabera clement diector of health from kabera to everyone: 10:59 AM Ndayisabye Daniel Saho from UWAMARIYA Jeannette to everyone: 11:01 AM my email: [email protected] from Dr NZARAMBA Theoneste to everyone: 11:01 AM Dr nzaramba Theoneste,DG of mibilizi DH, email; [email protected] from alphage2000 to everyone: 11:02 AM [email protected] from alphage2000 to everyone: 11:02 AM Nyamasheke District team: from alphage2000 to everyone: 11:03 AM Hagengimana Alfred director of health, Nyirabambanza Clementine Hygiene and sanitation officer (Nyamasheke District)

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Photo gallery: Virtual Health Sector/District Admin Consultation Session Oct 16, 2020

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Stakeholder Engagement Plan (SEP) Rwanda COVID-19 Emergency Response Project

IV. DHSOs/EHOs/C-EHOs Consolation Oct 12-15, 2020

Names of Officer HCF Function 1 Mfitumugisha Emmanuel Mudende HC Community Environmental Health Officer 2 Twizerimana Audace Biruyi HC Community Environmental Health Officer 3 Nikuze Justine Kinunu HC Community Environmental Health Officer 4 Mukamana Gervasie Murunda HC Community Environmental Health Officer 5 Uwingabiye Chrlotte Cyimbiri HC Community Environmental Health Officer 6 Ufitinema Emertha Karumbi HC Community Environmental Health Officer 7 Musabyimana Xaverne Kabona HC Community Environmental Health Officer 8 Nizeyimana Bahizi Emmanuel Mukura HC Community Environmental Health Officer 9 Sinibagiwe Adrien Kivumu HC Community Environmental Health Officer 10 Mukaneretse Alphonsine Musasa HC Community Environmental Health Officer 11 Nsengiyumva Gregoire Nyabirasi HC Community Environmental Health Officer 12 Sebazungu Jonathan Bitenga HC Community Environmental Health Officer 13 Uwamahoro Eugene Sigenyi DH Environmental Health Officer 14 Rudahusha Dieu Donnee Nyakiriba HC Community Environmental Health Officer 15 Nyirasafari Gaudence Kigufi HC Community Environmental Health Officer 16 Kayitare Jean Paul Gacuba HC Community Environmental Health Officer 17 Ntacyarutimana Thomas Busigari HC Community Environmental Health Officer 18 Karinganire JMV Bugeshi HC Community Environmental Health Officer 19 Uwayisabye Veneranda Murara hc Community Environmental Health Officer 20 Kabatesi Christine Karambo HC Community Environmental Health Officer 21 Masengesho Irenee Nyundo HC Community Environmental Health Officer 22 Harindintwari F Xavier Congonil HC Community Environmental Health Officer 23 Bagiyumugambi Joseph Mushubati HC Community Environmental Health Officer 24 Nkinzehiki Emmanuel Kibingo HC Community Environmental Health Officer 25 Mugarura Gabriel Kabari CH Community Environmental Health Officer 26 Nsekerabanzi Jackson Busasamana HC Community Environmental Health Officer 27 Kariwabo Felicien Passy Gisenyi HC Community Environmental Health Officer 28 Bizimungu Alain Byahi HC Environmental Health Officer 29 Sibomana Jean de Dieu Rutsiro HC Community Environmental Health Officer 30 Mutabazi Francois Kinihira HC Environmental Health Officer 31 Kwineza Esperance Kayove HC Community Environmental Health Officer

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Stakeholder Engagement Plan (SEP) Rwanda COVID-19 Emergency Response Project

Photo Gallery: Consultation/training of DHSOs, EHOs and C-EHOs 12-15 Oct 2020

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Stakeholder Engagement Plan (SEP) Rwanda COVID-19 Emergency Response Project

V. Summary of Key Issues Raised in SH Consolation Oct 12-15 and Oct 16 2020

Comments and Issues raised Stakeholder Reply from ESF Team &/or PIU Designation • Handwashing facilities are inadequate Director of Health - • PIU Coordinator: MoH found that Bugesera District there internal water supply challenges in some HCFs. These • There is need for assessment of water Director of Health - HCFs have been identified and will distribution within HCFs Gasabo District; be assisted to resolve the problem. • Presentation did not feature people with Director of Health - • ESF team: People disabilities are disabilities among the stakeholders Bugesera District included as key stakeholders of the ERP and referenced in this ESMF among vulnerable groups. • Current practice of home-based care is DG Gisenyi Hospital • PIU Coordinator: A capacity straining HCW capacity. HCW capacity needs assessment was done and challenges expected increase when borders results used in the COVID-19 open (e.g. 50,000 people crossing daily at National Preparedness and Rubavu-Goma border). Response Plan. • Has there been any HR capacity needs • PIU Coordinator: There is no assessment for C-19 response? budget for recruitment of • Is project considering recruiting additional additional HCWs. Most of the ERP non-civil service staff? budget is being used for logistical • EHOs & C-EHOs over-stretched, not able to EHOs/C-EHOs support for case-management follow appropriate schedule, resorting to Nyabihu/Ngororero and medical supplies. most urgent • How is the budget managed to mitigate Director of Health – • PIU Coordinator: ERP budget is implementation challenges? Rulindo District managed by RBC-SPIU according GoR guidelines for financial accountability and efficiency of delivery • The country is moving into the C-19 Director of Health - • ESF Team: This ESMF provides eradication phase. Is the ERP considering Gasabo District guidance on decommissioning of rehabilitation of facilities e.g. isolation and ERP facilities as the final stage of quarantine centers? project activities. • Some decontamination activities caused Director of Health - • ESF Team: ERP Grievance Redress damage of people’s properties. Will the ERP Gasabo District; Mechanism is intended to address compensate them? EHOs/C-EHOs problems that may emerge from Nyabihu/Ngororero project activities fairly and efficiently. Aggrieved parties should be facilitated to register these and other grievances in the GRM register using the “Incident Reporting Form” of the nearest HCF. GRM Incident Reporting Forms” are maintained by DHSOs, EHOs and C-EHOs how forward registered grievances to HCF Health & Safety Committee for resolution.

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Comments and Issues raised Stakeholder Reply from ESF Team &/or PIU Designation • Transportation of medical waste to district EHOs/C-EHOs • ESF Team: Noted for the hospitals for incineration is adhoc and staff Musanze/Rutsiro; attention of RBC-SPIU (PIU) rely on improvisation Nyabihu/Ngororero • Incineration expensive (Rwf1,600/kg at EHOs/C-EHOs Gisenyi Hospital); considered low priority in Nyabihu/Ngororero current situation of low budget • Incinerators maintenance costly (e.g. Gisenyi Hospital cost Rwf18m (USD18.6m) • No weighing scales and colour-coded waste EHOs/C-EHOs bags not available for medical waste Nyabihu/Ngororero characterization • Component 4 indicates zero cost. Is this RBC/IHDPC • ESF Team: Component for is CERC correct? and indeed zero cost to the ERP. • Will the ERP consider purchasing Director of Health – • ESF Team: ERP will not purchase incinerators for hospitals? Gasabo District incinerators for hospitals. • ERP should make consideration of hospitals EHO - Mibilizi DH without modern incinerators • ERP should make considerations for waste Director of Waste • ESF Team: Noted for the management in COVID-19 homebased Management Kicukiro attention of RBC-SPIU (PIU) care/treatment District

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